Pediatric Critical Care Medicine has developed as a clinical art based on extrapolated data from adult and animal studies. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) has supported a nascent Collaborative Pediatric Critical Research Network (CPCCRN) to transform Pediatric Critical Care from a pathophysiologically based art to an evidence-based scientific practice through innovative and cutting-edge, multi-disciplinary clinical investigations. Children's Hospital of Philadelphia (CHOP) is a large, diverse, multi-disciplinary, research intensive premiere pediatric academic health center. The 5-year research vision of CHOP in the 21^'century is to be "the preeminent institution dedicated to translational research for children." This vision is complementary to the commitment of the NICHD CPCCRN to achieve innovative research and provide a stronger scientific evidence basis for the care of the critically ill child. Moreover, the Critical Care programs at CHOP are international leaders in clinical critical care research. Therefore, the CHOP Critical Care Program is the ideal Clinical Site for the CPCRN. The CHOP Critical Care Group also has a long-term goal to improve outcomes following cardiac arrests in children. Cardiac arrests in children are a major public health problem: thousands of children in the U.S. have sudden cardiac arrests in hospitals each year and thousands more have out-of-hospital arrests. Many lives can be saved with effective cardiopulmonary resuscitation (CPR), yet CPR for children typically does not comply with life-saving CPR guidelines. Our hypothesis is that advisory goal-directed, real-time automated pediatric CPR feedback will: 1) improve compliance with CPR guidelines and, 2) thereby increase the rate of survival to hospital discharge with good neurobehavioral outcome at 12 months post-arrest by 10%. PUBLIC HEALTH RELEVANCE: Providing a strong scientific basis for pediatric critical care with this research network will ultimately save lives and improve neurobehavioral outcomes of our most precious commodity, our children. The intent of the CHOP CPR proposal is to transform the field of pediatric resuscitation by demonstrating that advisory goal- directed real-time pediatric CPR feedback improves outcomes from in-hospital pediatric cardiac arrests.